The Evolving Landscape of Hepatocellular Carcinoma: A US Safety Net Collaborative Analysis of Etiology of Cirrhosis

Rachel M. Lee; Adriana C. Gamboa; Michael K. Turgeon; Adam Yopp; Emily L. Ryon; Joshua P. Kronenfeld; Neha Goel; Annie Wang; Ann Y. Lee; Sommer Luu; Cary Hsu; Eric Silberfein; Shishir K. Maithel; Maria C. Russell

doi:10.1177/0003134820939934

The Evolving Landscape of Hepatocellular Carcinoma: A US Safety Net Collaborative Analysis of Etiology of Cirrhosis

Rachel M. Lee, Adriana C. Gamboa, Michael K. Turgeon, Adam Yopp, Emily L. Ryon, Joshua P. Kronenfeld, Neha Goel, Annie Wang, Ann Y. Lee, Sommer Luu, Cary Hsu, Eric Silberfein, Shishir K. Maithel, Maria C. Russell

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Background: Hepatitis C virus (HCV) has historically been the most common cause of cirrhosis and hepatocellular carcinoma (HCC) in the United States. With improved HCV treatment, cirrhosis secondary to other etiologies is increasing. Given this changing epidemiology, our aim was to determine the impact of cirrhosis etiology on overall survival (OS) in patients with HCC. Methods: All patients with cirrhosis and primary HCC from the US Safety Net Collaborative (2012-2014) database were included. Patients were grouped into “safety net” and “academic” based on where they received their care. The primary outcome was the OS. Results: 1479 patients were included. The average age was 60 years and 78% (n = 1156) were male. 56% (n = 649) received care at academic and 44% (n = 649) at safety net hospitals. The median model for end-stage liver disease (MELD) was 10 (IQR 8-16). Median OS was 23 months. Etiology of cirrhosis was viral hepatitis 56% (n = 612), alcohol abuse 14% (n = 152), alcohol and hepatitis 23% (n = 251), and other 7% (n = 85). Patients with alcohol-related cirrhosis (alcohol alone or with hepatitis) were younger (59 vs 62 years), more likely to be male (86% vs 75%), treated at a safety net facility (45% vs 35%), uninsured (17% vs 13%), and had a higher MELD (median 12 vs 10) (all P < .003). They were less likely to have been screened for HCC within 1 year of diagnosis (20% vs 29%) and to receive treatment (69% vs 81%), and more likely to present with stage IV disease (21% vs 15%) (all P < .001). Patients with alcohol-related cirrhosis had decreased OS (5-year OS 24% vs 40%, P < .001), which persisted in a subset analysis of both academic and safety net populations. Conclusion: Although not significant on MVA, alcohol-related cirrhosis is associated with all factors that correlate with decreased survival from HCC. Efforts must focus on this vulnerable patient population to optimize screening, treatment, and outcomes.

Original language	English (US)
Pages (from-to)	865-872
Number of pages	8
Journal	American Surgeon
Volume	86
Issue number	7
DOIs	https://doi.org/10.1177/0003134820939934
State	Published - Jul 2020

Keywords

Cancer disparities
Cirrhosis etiology
Hepatocellular carcinoma

ASJC Scopus subject areas

Surgery

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10.1177/0003134820939934

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Lee, R. M., Gamboa, A. C., Turgeon, M. K., Yopp, A., Ryon, E. L., Kronenfeld, J. P., Goel, N., Wang, A., Lee, A. Y., Luu, S., Hsu, C., Silberfein, E., Maithel, S. K., & Russell, M. C. (2020). The Evolving Landscape of Hepatocellular Carcinoma: A US Safety Net Collaborative Analysis of Etiology of Cirrhosis. American Surgeon, 86(7), 865-872. https://doi.org/10.1177/0003134820939934

@article{d91649f211764b1baf0d66521e3e829c,

title = "The Evolving Landscape of Hepatocellular Carcinoma: A US Safety Net Collaborative Analysis of Etiology of Cirrhosis",

abstract = "Background: Hepatitis C virus (HCV) has historically been the most common cause of cirrhosis and hepatocellular carcinoma (HCC) in the United States. With improved HCV treatment, cirrhosis secondary to other etiologies is increasing. Given this changing epidemiology, our aim was to determine the impact of cirrhosis etiology on overall survival (OS) in patients with HCC. Methods: All patients with cirrhosis and primary HCC from the US Safety Net Collaborative (2012-2014) database were included. Patients were grouped into “safety net” and “academic” based on where they received their care. The primary outcome was the OS. Results: 1479 patients were included. The average age was 60 years and 78% (n = 1156) were male. 56% (n = 649) received care at academic and 44% (n = 649) at safety net hospitals. The median model for end-stage liver disease (MELD) was 10 (IQR 8-16). Median OS was 23 months. Etiology of cirrhosis was viral hepatitis 56% (n = 612), alcohol abuse 14% (n = 152), alcohol and hepatitis 23% (n = 251), and other 7% (n = 85). Patients with alcohol-related cirrhosis (alcohol alone or with hepatitis) were younger (59 vs 62 years), more likely to be male (86% vs 75%), treated at a safety net facility (45% vs 35%), uninsured (17% vs 13%), and had a higher MELD (median 12 vs 10) (all P < .003). They were less likely to have been screened for HCC within 1 year of diagnosis (20% vs 29%) and to receive treatment (69% vs 81%), and more likely to present with stage IV disease (21% vs 15%) (all P < .001). Patients with alcohol-related cirrhosis had decreased OS (5-year OS 24% vs 40%, P < .001), which persisted in a subset analysis of both academic and safety net populations. Conclusion: Although not significant on MVA, alcohol-related cirrhosis is associated with all factors that correlate with decreased survival from HCC. Efforts must focus on this vulnerable patient population to optimize screening, treatment, and outcomes.",

keywords = "Cancer disparities, Cirrhosis etiology, Hepatocellular carcinoma",

author = "Lee, {Rachel M.} and Gamboa, {Adriana C.} and Turgeon, {Michael K.} and Adam Yopp and Ryon, {Emily L.} and Kronenfeld, {Joshua P.} and Neha Goel and Annie Wang and Lee, {Ann Y.} and Sommer Luu and Cary Hsu and Eric Silberfein and Maithel, {Shishir K.} and Russell, {Maria C.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2020",

year = "2020",

month = jul,

doi = "10.1177/0003134820939934",

language = "English (US)",

volume = "86",

pages = "865--872",

journal = "American Surgeon",

issn = "0003-1348",

publisher = "Southeastern Surgical Congress",

number = "7",

}

TY - JOUR

T1 - The Evolving Landscape of Hepatocellular Carcinoma

T2 - A US Safety Net Collaborative Analysis of Etiology of Cirrhosis

AU - Lee, Rachel M.

AU - Gamboa, Adriana C.

AU - Turgeon, Michael K.

AU - Yopp, Adam

AU - Ryon, Emily L.

AU - Kronenfeld, Joshua P.

AU - Goel, Neha

AU - Wang, Annie

AU - Lee, Ann Y.

AU - Luu, Sommer

AU - Hsu, Cary

AU - Silberfein, Eric

AU - Maithel, Shishir K.

AU - Russell, Maria C.

PY - 2020/7

Y1 - 2020/7

N2 - Background: Hepatitis C virus (HCV) has historically been the most common cause of cirrhosis and hepatocellular carcinoma (HCC) in the United States. With improved HCV treatment, cirrhosis secondary to other etiologies is increasing. Given this changing epidemiology, our aim was to determine the impact of cirrhosis etiology on overall survival (OS) in patients with HCC. Methods: All patients with cirrhosis and primary HCC from the US Safety Net Collaborative (2012-2014) database were included. Patients were grouped into “safety net” and “academic” based on where they received their care. The primary outcome was the OS. Results: 1479 patients were included. The average age was 60 years and 78% (n = 1156) were male. 56% (n = 649) received care at academic and 44% (n = 649) at safety net hospitals. The median model for end-stage liver disease (MELD) was 10 (IQR 8-16). Median OS was 23 months. Etiology of cirrhosis was viral hepatitis 56% (n = 612), alcohol abuse 14% (n = 152), alcohol and hepatitis 23% (n = 251), and other 7% (n = 85). Patients with alcohol-related cirrhosis (alcohol alone or with hepatitis) were younger (59 vs 62 years), more likely to be male (86% vs 75%), treated at a safety net facility (45% vs 35%), uninsured (17% vs 13%), and had a higher MELD (median 12 vs 10) (all P < .003). They were less likely to have been screened for HCC within 1 year of diagnosis (20% vs 29%) and to receive treatment (69% vs 81%), and more likely to present with stage IV disease (21% vs 15%) (all P < .001). Patients with alcohol-related cirrhosis had decreased OS (5-year OS 24% vs 40%, P < .001), which persisted in a subset analysis of both academic and safety net populations. Conclusion: Although not significant on MVA, alcohol-related cirrhosis is associated with all factors that correlate with decreased survival from HCC. Efforts must focus on this vulnerable patient population to optimize screening, treatment, and outcomes.

AB - Background: Hepatitis C virus (HCV) has historically been the most common cause of cirrhosis and hepatocellular carcinoma (HCC) in the United States. With improved HCV treatment, cirrhosis secondary to other etiologies is increasing. Given this changing epidemiology, our aim was to determine the impact of cirrhosis etiology on overall survival (OS) in patients with HCC. Methods: All patients with cirrhosis and primary HCC from the US Safety Net Collaborative (2012-2014) database were included. Patients were grouped into “safety net” and “academic” based on where they received their care. The primary outcome was the OS. Results: 1479 patients were included. The average age was 60 years and 78% (n = 1156) were male. 56% (n = 649) received care at academic and 44% (n = 649) at safety net hospitals. The median model for end-stage liver disease (MELD) was 10 (IQR 8-16). Median OS was 23 months. Etiology of cirrhosis was viral hepatitis 56% (n = 612), alcohol abuse 14% (n = 152), alcohol and hepatitis 23% (n = 251), and other 7% (n = 85). Patients with alcohol-related cirrhosis (alcohol alone or with hepatitis) were younger (59 vs 62 years), more likely to be male (86% vs 75%), treated at a safety net facility (45% vs 35%), uninsured (17% vs 13%), and had a higher MELD (median 12 vs 10) (all P < .003). They were less likely to have been screened for HCC within 1 year of diagnosis (20% vs 29%) and to receive treatment (69% vs 81%), and more likely to present with stage IV disease (21% vs 15%) (all P < .001). Patients with alcohol-related cirrhosis had decreased OS (5-year OS 24% vs 40%, P < .001), which persisted in a subset analysis of both academic and safety net populations. Conclusion: Although not significant on MVA, alcohol-related cirrhosis is associated with all factors that correlate with decreased survival from HCC. Efforts must focus on this vulnerable patient population to optimize screening, treatment, and outcomes.

KW - Cancer disparities

KW - Cirrhosis etiology

KW - Hepatocellular carcinoma

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The Evolving Landscape of Hepatocellular Carcinoma: A US Safety Net Collaborative Analysis of Etiology of Cirrhosis

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